Arthroscopic repair of partial-thickness tears of the rotator cuff

Deutsch, Allen

doi:10.1016/j.jse.2006.07.001

Cited by 116 publications

(78 citation statements)

References 22 publications

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“…Debridement, with or without acromioplasty, was advocated [2,3], but the current trend is to repair lesions involving more than 50 % of the tendon thickness, or exceeding 6 mm (Grade 3) of depth [4]. The present evidence favours conversion from partial into full thickness, and repair of the tear in a traditional fashion [5,6], or a trans-tendon repair [7,8]. Both techniques are effective in functional recovery and relief of symptoms, but controversy persists because of the lower morbidity rate and earlier recovery when completing and repairing tear, whereas tendon integrity, native footprint, and biomechanical properties (gapping and mean ultimate failure strength) are better restored when performing a transtendon repair, leaving the bursal side intact [9,10].…”

Section: Introductionmentioning

confidence: 80%

“…The main finding of our study is that transtendon repair and repair after tear completion are both effective to manage articular sided PTRCTs, both for clinical and imaging results. Repair after tear completion may be very satisfying [5,14]: it allows freeing the tendon footprint from degenerated scar tissue potentially impairing the healing process, but some biomechanically functional healthy tendon may have to be sacrificed, making the repair weaker [15]. Complete removal of the cuff insertion makes also it difficult to anatomically repair the lesion and restore the native tendon footprint, resulting in biological and mechanical flaws.…”

Section: Discussionmentioning

confidence: 99%

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Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Franceschi

Papalia

Buono

et al. 2013

International Orthopaedics (SICOT)

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Purpose To compare two groups of patients who underwent two different arthroscopic procedures for repair of articularsided partial-thickness rotator cuff tears (PTRCTs). Materials this is a comparative prospective study of two methods for repair of partial cuff tears Thirty-two patients underwent arthroscopic rotator cuff repair with a transtendon technique (group 1); 28 underwent arthroscopic full-thickness conversion and repair of the lesion (group 2). ROM measures, clinical findings, MRI features (tendon healing and re-tear), Constant-Murley and ASES scores were assessed pre-and postoperatively and compared. Patients were also asked about return to sport and level of activity. Results At the last appointment, patients of both the groups were significantly improved for clinical findings, ROM measures, imaging features, Constant-Murley and ASES scores than at baseline, without any significant inter-group difference. In group 1, 15 of 20 patients (75 %) who practiced recreational sport activities had returned to sport at the same level as before the onset of symptoms, without any discomfort. In group 2, 12 of 18 patients (67 %) had returned to the same level of sport activity they practiced before symptoms. At the last follow up, MRI showed rotator cuff healing in 31 patients of Group 1 and 27 patients of Group 2 (p=0.83). Conclusions The two procedures are safe, effective, and comparable.

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Section: Introductionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Franceschi

Papalia

Buono

et al. 2013

International Orthopaedics (SICOT)

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“…Previous authors have reported substantial increases in American Shoulder and Elbow Surgeons scores by converting the PASTA lesion to a full-thickness tear and then repairing the full-thickness tear [4,11]. Kamath et al [11] did however report five nonhealing events in 42 patients treated in this fashion.…”

Section: Discussionmentioning

confidence: 95%

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Spencer

2010

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of partial-thickness articular surface rotator cuff tears varies from simple débridement with or without an acromioplasty to various repair techniques. These repair techniques have included in situ transtendinous methods, as well as completion of the tear and repairing the full-thickness defect. The transtendinous techniques can be associated with stiffness and completing the tear takes down normal intact tissue. Therefore, a technique was developed that repairs the articular-side partial-thickness rotator cuff tears with an all-inside approach that does not violate the intact bursal tissue and does not complete the tear. Questions/purposes To compare the preoperative and postoperative Penn shoulder scores (PSS) associated with an in situ all-inside repair technique and the effects of such a repair on postoperative stiffness. Methods Twenty patients with partial-thickness articular rotator cuff tears greater than 50% of the width of the tendon repaired with an all-inside repair technique were retrospectively reviewed. Two of the patients were high school athletes and the rest self-described as recreational athletes. The minimum followup was 16 months (average, 29 months; range, 16-41 months). A validated outcome measure (PSS) was used to assess clinical outcome, and postoperative ROM was measured. Results The average PSS score improved from 74 (range, 56-84) to 92 (range, 86-99).

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“…31,69,71,72 Although encouraging, it is worth pointing out that these studies have not assessed outcome in high-level overhead athletes, and one must exercise caution in extrapolating results to this population. The few studies in which partial-thickness cuff tears have been repaired in throwers reinforce this message.…”

Section: Repair Techniquesmentioning

confidence: 99%

Rotator Cuff Tears in the Throwing Athlete

Shaffer

Huttman

2014

Sports Medicine and Arthroscopy Review

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Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time.

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Arthroscopic repair of partial-thickness tears of the rotator cuff

Cited by 116 publications

References 22 publications

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Articular-sided rotator cuff tears: which is the best repair? A three-year prospective randomised controlled trial

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Rotator Cuff Tears in the Throwing Athlete

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